DESCRIPTION: Short course anti-retroviral treatment has been shown to significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. HIV voluntary counseling and testing (VCT) is a key entry point for women to receive MTCT prevention services, including ARV prophylaxis. VCT also provides other benefits to the woman beyond prevention of mother-to-child-transmission. However, data from a host of antenatal clinics offering HIV VCT and ARVs in East Africa show that many women are not consenting to HIV VCT, and among women who are tested, large proportions do not return for their test results. In this study, we propose to examine factors that affect pregnant women's decisions to accept HIV VCT and to return for their test results using a theoretical framework that extends beyond individual barriers to include barriers in the social and testing environment. The study will be conducted in Tanzania among women attending antenatal clinics offering HIV VCT and ARV prophylaxis. Specific aims include: 1) To qualitatively identify perceived barriers of accepting VCT and receiving test results; and 2) To assess the impact of individual, relational, and environmental factors on the perceived benefits and barriers to testing. A cross-sectional design using both qualitative and quantitative methods will be used to answer the study aims. For aim 1, in-depth interviews will be conducted with women attending antenatal services and the counselors providing the services. For aim 2, a quantitative survey among a representative sample of women attending antenatal clinics will be conducted. Information from this study will help elucidate important barriers to the acceptance of VCT and allow the design of appropriate interventions.